Mounted search and rescue

["IRVIN LICHTENSTEIN" <ilichten1@verizon.net>]

The patient's condition is the decision point. If advanced life support
procedures are necessary in transit, whether due to trauma, hypo or hyper
thermia, attempting to do so while a patient is moving in a vehicle or
litter is difficult.  
The usual flags set for authorizing helicopter evacuation to a trauma center
or advanced care location include: 
-multiple (body) system damage 
-presence of a fatality on the scene
-head trauma with loss of consciousness or change in mental state
-traumatic injuries requiring surgical intervention to preserve life
(collapsed lung, a trach beyond the needle machine capability, etc.)
-extrication lasting more than 20-40 minutes (varies with jurisdiction)
-ground transport time in excess of 20 minutes
-exposure to poisons that cannot be treated in the field or anaphylaxis

A person properly secured in a Stokes litter with shield can be transported
on a pack frame, a travois, or similar means when care in route is not more
elaborate than checking condition periodically and accessing IV sites. Use
of a Stokes provides a metal frame around the patient, room for a backboard
and cervical immobilization, and the placement of a weather or debris shield
over the patient.  Because of its design the Stokes can be carried, hoisted,
short hauled, equipped with floats, or other adaptations during the
transport without having to shift the patient.  

Solid body (plastic) Stokes should never be used if a hoist or short haul by
helicopter is possible as they often spin.  When placing a patient in a
Stokes in rough terrain they should first be secured to a back board with a
separate lifting spider.  This will allow the patient to be easily lifted
from the basket on arrival. Preferably the backboard should be x-ray
transparent and include the CID.  If the Stokes has to be high lined with
the patient the separate spider provides a backup as well.  

The bottom line is that if a patient needs advanced medical care now he
needs a helicopter now.  If the search manager or logistics officer is
worried about the bill for a live patient he is in the wrong business.
The risks associated with recoveries are different but the level of care is
also different.  Don't ask for a helicopter if there is no visibility, the
altitude is too high, or the range is too far.  The leading cause of
aeromedical helicopter accidents is trying too hard to get there, so don't
even ask if the conditions are bad, they'll come anyway.

Irv Lichtenstein     

-----Original Message-----
From: msar-riders-bounces@lists.ibiblio.org
[mailto:msar-riders-bounces@lists.ibiblio.org] On Behalf Of Jorene Downs
Sent: Thursday, July 02, 2009 11:24 PM
To: 'Mounted search and rescue'
Subject: Re: [MSAR] [SAR-L] Transport decision tree / Helo Decision trees
and guides